[Emergencies in gastroesophageal varices hemorrhage in the patient with portal hypertension]. / L'urgenza emorragica da varici esofago-gastriche nel paziente iperteso portale.

ABSTRACT

High gastrointestinal hemorrhage represents the more frequent (12-71.1%) and heavy complication of hepatic cirrhosis and correlates to portal hypertension; it is weighed by global mortality which sways from 30 to 50%. High gastrointestinal hemorrhage gives, therefore, a serious of diagnostic and therapeutic problems not easy to guide for at least 3 reasons numerous causes of bleeding; hepatic failure; the marigold possible therapies. Aim of this work is to clarify some diagnostic and therapeutic features about high gastrointestinal hemorrhage in cirrhotic patient, because such eventuality often presents dramatic aspects, which endangers the patient's life. Our experience shows a casuistry referred to the period of time which goes from 1987 to 1998 and that comprehend 143 examined patients 91 of theme have been submitted to medical treatment (endoscopic sclerotherapy, glupressin e/o somatostatin); in 52 cases it has been possible to realize a surgical treatment, different from the elective therapy (33 pz) and emergency therapy. Immediate hemostatic effect obtained in both the conditions, has been satisfying with best results at a distance of three years and five years given by devascularization. As matter stands our preference of the devascularization surgical treatment, it seems appropriate to pay attention to the operation of mesocaval anastomosis which, either in Our very brief experience (3 cases) or by international literature, seems to offer encouraging results.